Wafaa F Abdallah, NURSE PRACTITIONER
Individual provider Active NPI Acute Care Nurse Practitioner · Dearborn, MI
NPI 1891200440 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1891200440
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- License
- 4704281995 (MI)
- Practice address
- 15400 Michigan Ave
Dearborn, MI 48126-3491 - Phone
- (313) 584-3359
- NPI assigned
- Dec 5, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Senior Care Medical Group PLLC
Practice addresses (Care Compare)
15400 Michigan Ave
Suite 1
Dearborn, MI 48126-3491
Phone (313) 584-3359
Hospital & facility affiliations
- Beaumont Hospital - Dearborn
- Beaumont Hospital - Taylor
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180124001218 | MI | Practitioner - Nurse Practitioner | 3577466853 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704281995 | MI | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pulse Primary Care PLLC | Current |
Accepting new patients | |
| Senior Care Medical Group PLLC | Current |
Accepting new patients |
Locations
15400 Michigan Ave
Dearborn, MI 48126
Phone (313) 584-3359
15400 Michigan Ave
Ste 1
Dearborn, MI 48126
Phone (313) 207-5767
18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780
23550 Park St
Ste 201
Dearborn, MI 48124
Phone (313) 277-0075
36555 26 Mile Rd
Ste 3600
Lenox, MI 48048
Phone (313) 207-5767
39000 7 Mile Rd
Ste 2800
Livonia, MI 48152
Phone (586) 701-2300
Interoperability endpoints
- wabdallah1221786@epic00.shdirect.org
- https://fhir4.healow.com/fhir/r4/IAGHDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 4704281995 | MI | Yes |
Addresses
Primary practice location
15400 Michigan Ave
Dearborn, MI 48126-3491
Mailing address
15400 Michigan Ave
Dearborn, MI 48126-3491
Phone (313) 584-3359
Other practice location 1
18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone (313) 584-3359
Other practice location 2
18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone (313) 584-3359
Other providers in Dearborn, MI
- Fatmeh Abdallah
- Hassan Khaled Abdallah
- Malak Abdallah
- Marriam Abdallah
- Mossab Abdallah
- Zeinab M Abdallah
- Zienab Nazih Abdallah
- Zinab Abdallah
- Hussein M. Abdel-Hak
- Ibrahim Husni Abdel-Jawad
All providers in Dearborn, MI · Acute Care Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.